Background/Purpose: Population-based studies suggest an association between musculoskeletal problems and an increased risk of falls. Patients with rheumatoid arthritis (RA) who have muscle weakness and stiff or painful joints might be at an increased risk of falling. But, no prospective cohort study concerning fall incidence in RA has been performed. This study used a prospective cohort design to determine the incidence of falls and to elucidate their risk factors in patients with RA who participated in the TOMORROW study (UMIN000003876) that was started in 2010.

 Methods: We have started the TOMORROW study examining several risk factors affecting RA. The participants in the study consist of 202 RA patients (109 patients receiving biological agents) and 202 age-and sex-matched healthy volunteers were collected through mass media as controls. As a baseline, all participants completed a self-administered questionnaire on general health status. Laboratory data and anthropometric parameters were also collected. Body composition was determined by whole body dual X-ray absorptiometry. Vertebral fractures using thoracolumbar spine X-rays were evaluated. In addition, incidence of falls was tracked with a “fall calendar” for 3 years and we collected the calendar yearly.

Results: The incidence of having at least one fall during the 3-year period did not significantly differ between the patients and controls (37.1% vs. 30.2%, NS). However, the patients fell significantly more often than controls (2.48 vs.1.74 falls; p = 0.03) and had a higher prevalence of vertebral fractures (46% vs. 30%) and semiquantitative (SQ) grade ≥2 (15% vs. 5%) than the controls. After adjusting for risk factors of falls such as age, gender, smoking and BMI, multiple logistic regression analysis identified that a history of falls was the most significant parameter associated with the incidence of falls (odds ratios: all, 2.49, p < 0.001; patients, 1.98, p = 0.047; controls, 3.60, p = 0.017). Existing vertebral fractures and SQ grade ≥2 did not correlate with the incidence of falls. Multiple regression analysis revealed that the number of falls experienced by patients with RA was associated with the dosage of prednisolone (PSL; β = 0.214, P = 0.027,) and matrix metalloproteinase-3 (MMP-3; β = 0.141, P = 0.046) (Table 1.).

Conclusion: We evaluated the associated risk factors for falls in RA patients. Multiple falls in RA patients were significantly higher than in controls over the past three years. In RA patients, history of fall and a prednisolone use were associated with falls. The patients who fell at least once tend to fall again. To prevent falls, various interventions are necessary for the patients.

Table 1. Association between number of falls and parameters adjusted for potential confounders for falls.

Multivariate	RA patients
number of falls	β	P value
mHAQ	0.071	0.347
Prednisolone  (PSL: mg/day)	0.214	0.027
MMP-3	0.141	0.046
Whole BMD (mg/cm2)	-0.020	0.843
Body fat (kg)	0.181	0.201
Walking period(min/day)	0.044	0.535

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-dosage-of-prednisolone-is-a-risk-factor-for-falls-in-rheumatoid-arthritis-patients-the-third-year-results-of-the-tomorrow-study/